Representatives of Louisiana doctors and hospitals expressed opposition Wednesday to a newly negotiated Senate health care proposal that would allow uninsured Americans between 55 and 64 to buy into the federal Medicare program.

Dr. Patrick Breaux said he opposes expanding Medicare, largely because it covers only about 80 percent of costs.

Dr. Patrick Breaux, a New Orleans cardiologist and president-elect of the Louisiana Medical Association, said as a provider he would have a major objection to expanding Medicare -- mainly because it covers only about 80 percent of costs.

As a result, he said, it's likely that the kind of expansion being considered by the Senate would force providers and insurance companies to pass on the shortfalls in reimbursements to privately covered plans and patients, meaning bigger increases for people who already have coverage.

Paul Salles, president and CEO of the Metropolitan Hospital Council of New Orleans, said an expansion of Medicare would cause a big financial hit for his 17-member hospitals because of the reimbursement rates.

Democratic leaders have hailed the proposal as a major breakthrough in moving the health care legislation forward, but Sen. Mary Landrieu, D-La., one of the 10 senators who helped draw up the plan, said the proposal is far from a done deal because the Congressional Budget Office hasn't completed a cost analysis.

"We, all 10 of us, think that's a very good idea given our negotiations," Landrieu said. "But until we get a score, nothing will be settled."

Paul Salles is president and CEO of the Metropolitan Hospital Council of New Orleans.

One of several Senate moderates who opposes a government-run option to compete with private insurance companies, Landrieu said the expanded age group for Medicare would cover many small-business employees and owners who can't afford coverage on the open market but might be able to afford coverage through the existing Medicare program -- without the need to set up a new federal program.

Federal employee pool

In addition to expanding Medicare, one component of the deal negotiated by the 10 Democratic senators, including some of the party's most liberal and conservative lawmakers, involves a variation of the coverage now provided to federal employees, including members of Congress.

Insurers participating in the lucrative federal employee pool, which is attractive to insurers because of the larger numbers of participants, would have to offer their coverage -- regulated by the Office of Personnel and Management -- to nongovernment workers nationally if the government can't find two carriers to sell affordable plans nationwide to increase competition.

Landrieu, chairwoman of the Senate Small Business Committee, said the existing health care bill already has incentives to help small businesses buy coverage for their owners and employees and that she's working with other senators to expand those incentives.

Smaller companies, she said, have the hardest time providing coverage because rates have been going up dramatically and firms are often hit with huge increases in premiums when a single participant suffers an expensive illness.

Senate Majority Leader Harry Reid, D-Nev., continued to express optimism that the Senate will pass health legislation before it breaks for Christmas.

"When we pass this bill, 31 million Americans who today have no health insurance whatsoever will at long last be able to afford it," Reid said.

But Republicans remained skeptical.

"I don't believe there is any 'deal' right now that has 60 votes behind it," Sen. David Vitter, R-La., said. "In terms of Harry Reid's brand new plan (the seventh mega-health-care plan and counting), it sounds like it would cost even more than the Reid bill currently on the floor and still involve a massive expansion of the federal government's role, this time through potentially doubling Medicare, which is already going broke."

Melancon weighs in

As the Senate continues debate, there are signs that the issue will bleed over into next year's U.S. Senate race between Vitter and his chief Democratic challenger, Rep. Charlie Melancon of Napoleonville.

While Melancon voted against the House version of the health-care bill, and Vitter is opposed to the Senate measure. Melancon on Wednesday sought to draw attention to an amendment proposed by Sen. Tom Coburn, R-Okla., to strip out $300 million in federal support to shore up Louisiana's Medicaid program. Vitter, who has joined Gov. Bobby Jindal and the rest of the state's congressional delegation in fighting for more Medicaid dollars, has not said how he will vote on the amendment.

"It would be like the Saints (offensive) line just peeling away and letting the defensive rushers get Drew Brees," Melancon said, who urged Vitter to oppose Coburn's proposal. "If the senator from the state that's affected will not stand up to the Senate and say, 'I need your help for the people that I represent' ... that's just wrong."

The Medicaid fix language was added by Landrieu, who used her leverage as a swing vote on the legislation.

Vitter's spokesman, Joel DiGrado, said the senator supports getting more money to fix Louisiana's Medicaid shortfall, "but the best analysis he has received is that the language in the Reid bill is not a complete fix."

Louisiana Health and Hospitals Secretary Alan Levine said calculations done by his agency suggest the language added by Landrieu would give Louisiana an additional $112 million in the 2010-11 budget year and $265 million the following year. But that's hardly enough, he said, to shore up Medicaid shortfalls totaling $1.4 billion over the same time frame because of a loss of federal stimulus dollars and declining federal participation in the program.

"What's in the (Senate) bill is nothing more than a temporary, partial solution," Levine said. "I know she's worked hard to get it there. I do hope that she'll continue to work with us after this debate, because this is going to be an ongoing problem."Capital bureau reporter Jan Moller contributed to this report.